权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

The Hospital to Home Study: A Pragmatic Trial to Optimize Transitions and Address Disparities in Asthma Care

从医院到家庭研究：优化过渡和解决哮喘护理差异的务实试验

基本信息

批准号：
10583611
负责人：
Kavita Parikh
金额：
$ 90.7万
依托单位：
CHILDREN'S RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-01-01 至 2027-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10583611
关键词：
Academic achievement Acute Address Admission activity Adolescent Adult Affect American Asthma COVID-19 pandemic effects Caregivers Caring Child Child Care Child health equity Childhood Childhood Asthma Chronic Disease Clinical Cognition Community Hospitals Dedications Disease Disparity Emergency department visit Face Feedback Goals Guidelines Hand Health Home Hospitalization Hospitalized Child Hospitals Individual Infrastructure Inpatients Intervention Interview Methods Mission Morbidity - disease rate National Heart, Lung, and Blood Institute Outcome Participant Pediatric Hospitals Pediatric Research Pharmaceutical Preparations Prevention Preventive Health Services Public Health Quality of Care Reduce health disparities Research Resources School Drop-Outs School-Age Population Schools Site Student Dropouts Testing United States National Institutes of Health Update Variant Work Youth acceptability and feasibility aged asthma exacerbation child services clinical practice community engagement comparison intervention disorder control disparity reduction effectiveness/implementation trial evidence base follow-up group intervention health care disparity health care service utilization health disparity health equity promotion health outcome disparity high risk high risk population hospital readmission implementation evaluation implementation facilitators implementation intervention improved improved outcome innovation insight interdisciplinary approach mortality multi-component intervention novel patient oriented pilot trial pragmatic trial premature primary care provider programs provider communication racial disparity randomized trial recruit socioeconomics standardize guidelines successful intervention telehealth trial design trial enrollment usual care arm

项目摘要

Despite evidence-based NIH guidelines for asthma, overall morbidity among children has not significantly decreased. In the US, asthma accounts for >150,000 hospitalizations, >600,000 emergency department visits, and nearly 14 million missed school days annually. Striking socioeconomic and racial inequities persist with under-resourced children incurring a disproportionate share of asthma morbidity. Our long-term goal is to improve health outcomes and reduce disparities in asthma morbidity for all children. Our team will address critical barriers to achieving broad-scale improvements in outcomes for all children hospitalized with asthma in the US, in any setting. This proposal’s overall objective is to improve asthma outcomes by conducting a patient-centered, multicomponent intervention focusing on under-resourced children with asthma at both children’s (ChH) and community hospitals (CH). Intervention components are navigation support, medications in-hand at discharge, primary care provider communication, school-based therapy, and home assessment. Leveraging feedback from stakeholders and building on the telehealth infrastructure, we will utilize a pragmatic effectiveness-implementation trial design to test the overall hypothesis that a refined version of the Hospital-to- Home (H2H) intervention will reduce asthma readmissions over a 12-month follow-up period. The hypothesis will be tested in the following aims. (1): Engage key stakeholders to identify barriers and facilitators for implementation of the components of H2H at children’s (ChH) and community hospitals (CHs). We will conduct qualitative interviews to identify barriers and facilitators and refine each component for optimal implementation. (2): Evaluate health outcomes of the H2H intervention compared to usual care control group for children hospitalized with an asthma exacerbation at ChH and CH sites. We propose a multi-center, randomized trial enrolling 340 caregiver-child (aged 4-12yrs) dyads during hospitalization to a multi-component intervention. (3): Evaluate implementation of each component of the H2H intervention and assess impact of implementation on health outcomes. We will evaluate feasibility, acceptability, and fidelity using mixed-methods to assess variation in implementation of each component across sites and their impact on health outcomes. By focusing on broader implementation at both ChHs and CHs, this innovative proposal has significant implications for improving asthma management and reducing health disparities incurred by under-resourced school-aged children. This proposal is aligned with NIH’s mission to address health disparities and will provide crucial insights in intervention implementation at all types of hospital settings that care for children. Because the hospitalization for children with asthma serves a high-risk population who may otherwise be difficult to reach, identifying the most clinically effective method by which to deliver a preventative health service is urgently needed. This work has the potential to shift current hospitalization clinical practice paradigms from only acute encounters for asthma exacerbations to the broader management of public health prevention.

尽管有基于证据的NIH哮喘指南，儿童的总体发病率并没有显著提高